scrubs and anesthesiology

[needadvice]

scrubs,

we all appreciate your input. thanks for sharing your input. as a categorical medicine intern, let me tell you what i find frustrating in medicine.

1) nursing home placement and social work
2) feeling that i am not always doing much for my non compliant patients
3) VA clinic patients who only want viagra or oxycodone
4) the smell of a GI bleed
5) the nursing shortage (the best nurses seem to be in critical care and the or)

i do enjoy
1) the pathophysiology
2) the rare patient with one medical problem which i have time to treat
3) teaching

it is a tough decision for all of us deciding which path our careers should take.

good luck.

also, i know you can't say which program you're at in chicago, but if you had to the chance to pick a residency all over again, which anesthesiology program would you go to (it may or may not be the same one you're at)

best

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[jawurheemd]

scrubs,

just wondering what you did your prelim year in -- cuz that would mean that you have had some exposure to some other field -- how does that experience compare with your experience in anesthesiology?

-James

 

[scrubs]

Hi guys! Thanks for sharing your thoughts.

Needadvice - I totally understand your frustrations with medicine. I did a transitional year for my PGY-1 year, so I sort of know what the IM route is like. But what about subspecializing? I have a friend who is in IM and applying for allergy. He tells me this is the way to go... Or even rheumatology? I guess most people in anesthesia would consider these horribly boring specialties. But there is little stress, little call, no general medicine clinic (which would drive me crazy too!), and a fairly good lifestyle/income in these fields, right? Or am I totally off? Why would you not consider this route over going into anesthesia? Also, what about anesthesia appeals to you (i.e., maybe I forgot why I went into this specialty)?

As far as which program in Chicago to consider, I wish I had looked more closely at UIC (Univ. of Illinois at Chicago). I have a friend there who is a CA-1: no call entire CA-1 year, 30-minute conference every day from 6:30-7am (i.e., guaranteed teaching on some topic or board question review), and reasonable work schedule. Seriously look into it... I also have a friend at University of Michigan at Ann Arbor who is very happy with his choice.

James - I did a transitional year at a community hospital. The demands were considerably less. I feel that everything in anesthesia is critical at any given moment (difficult intubation/airway, sudden unexpected huge-volume blood loss, hypotension/hypertension, arrthymias, etc.). It is so unbelievably easy to cause major harm (even death) to a patient in this field. I am constantly terrified that something will happen. I also feel that I did not earn my M.D. just to be a servant to a surgeon. While I liked medicine my intern year, I did not love it. The irritations mentioned by "needadvice" were very common. I think I could see myself in a medicine subspecialty, however...

Thank you both again for your opinions - I really do appreciate your input.
Needadvice let me know if you have any specific questions about Chicago anesthesia programs.
Take care!

 

[GreatPumpkin]

needadvice

Why not consider switch to Pathology? The things you like are here. Combined with a great lifestyle. If everyday firsthand interaction with patients is not as important to you, path is awesome. And, on certain rotations (ie. transfusion medicine, heme path, and cytology) we see quite a few patients everyday. But, as a consultant dealing with one problem.

And for Scrubs, another great thing is we don't have the power struggle problems Anes. has. Also, your intern year can count as year one for path.

Just throwing out an idea. Good luck.

 

[needadvice]

scrubs,
again thanks for your perspectives. most in my intern class will probably sub specialize. the thought of general medicine is not appealing to most. allergy and rheumatology are both very relaxed specialties and the money in allergy is decent. the issue you will face is the pressure to see patients in a certain amount of time. i am not sure if you had the chance to do clinic during your transitional year, but i face an incredible amount of pressure to see patients quickly and get them out of the office before the next one comes in. i rarely have a chance to do my dicatation at the office and just today did six dictations in my apartment. that said, i am sure you could find a cush allergy practice where this wouldn't be so much of an issue. as a rheumatologist you will likely work in an academic center rather than private practice.

here's what i find appealing about anesthesiology:

1) the physiology : sometimes i find this more interesting than pathophysiology.

2) you can immediately see the results of your work. while some may say that this work is marginal and easy, i don't believe this is true. it takes an expert and that expert is an anesthesiologist.

3) the medicine is clean and pure. you are not worried about compliance issues.

4) pain medicine without the fibromyalgia patients, ie, cancer is interesting to me. i actually spend a great deal of time dealing with pain management on the floor and in clinic. i, however, can not stand neady patients.

5) the lifestyle is incredible compared to many other specialities and the money is good.

i for one, want to stay in academics. i like to teach, but i also want free time in my life. i am thinking about chicago cause i have a few friends there. i am looking to move to a city with young people. the city in which i am in, is not vibrant nor are there many single women i graduated in the top quarter of my class with boards of 222/238 and am not sure how competitive i will be to drop into a CA1 position. the most important thing for me is the comraderie in residency which i found extremely difficult to ascertain when i was interviewing in medicine.

e-mail me: [email protected]

best

 

[scrubs]

Hi Rob!

Could you tell me more about pathology? I honestly never considered it! What do you do as a pathologist during and after residency? What attracted you to the field? What kinds of personalities usually enter the field?

Any info would be helpful and educational!
Thanks in advance!

 

[GreatPumpkin]

Path is a diverse field with a real wide variety of people. There are multiple jobs a pathologist can do when all done. Most get board certified in both anatomic pathology (surgical pathology, cytopathology and autopsy) and clinical pathology (hematopathology, chemistry, microbiology, and blood bank). The job is normally very calm compared to the hectic pace of other specialties. The hours are very regular. Most weekends are off. Call is from home. Lots of teaching is required (med students, lab staff, resident to resident). Lots of studying as well. I love the AP side of path, each day is like being given visual puzzles/problems to figure out. The clinical path side is more supervisory. It is not bad and has its own puzzles. We don't spend a lot of time with patients but we do spend a lot of time interacting with people. Docs, nurses, etc. all over the hospital are always calling for advice and help. Most people treat the pathologist very well because many times we have the final answers they are looking for. I was between Anes. and Path my last year. What a difference. I did a rotation in Anes. and hated every second. I always felt rushed and pressured, people were not nice, it felt like a patient assembly line. Path was totally different. I am definately a type B or AB personality and path suits me well. That said there are type A people who love it as well. Starting pay is not as high as Anes., but not shabby either. Can start in the 150-170s easy, partnership in a few years then easily 200-300s. Derm path is even more. There is not a better university job than Pathologist. Of course pay is not as good as private practice, but what a great lifestyle.

Path is also a specialty you can switch into fairly easily. Not very competitive. My program has lots of switchers.

Let me know what I didn't answer. I will elaborate.

 

[Mindy]

Pathology is a wonderful, rewarding, diverse field which is never addressed well as a profession in medical school. I spent a year as a post-sophomore fellow in pathology functioning essentially as a 3rd year resident. In general the attendings are relaxed, happy (happier than any other set of doctors I have encountered), genuinely interested in students that are interested. The best pathologists are natural teachers who have an ability to translate what they see easily into words at all education levels. They are also quite off-beat... (If this irks you Great Pumpkin, realize I speak only for my institution!) Rearch opportunities are limitless with endless tissue available with minimal IRB conflict. Furthermore, autopsies (a turn-off for some, more enjoyable to others) are not necessarily a significant part of a pathology career. If I could give up my childhood dream of helping patients directly, I would become a pathologist in a heartbeat! I know this was vague, so if you want more specifics, just ask!

 

[Ludy]

Mindy,
I'm curious about the post-sophomore fellowhip. I've heard about it, and I would definitely consider it because I'm interested in path, but I don't know how to go about doing one. Do most schools offer them? Did you get paid? What kinds of activities did you do on a daily basis (all AP or both AP/CP, any research)? Thanks

 

[Mindy]

GP20: A post-sophomore fellowship occurs after your 2nd and 3rd years of medical school. I am at SUNY Upstate at Syracuse and did my fellowship there. I think there are a significant number of schools who do have the fellowship, particularly because it serves as a way to fill gaps in residency enrollment at the institution (myself and my fellow fellows considered ourselves a "1/2" resident, but in reality we did the work of 1 resident with half of the pay. The lack of cash is made up for in experience and third year does seem easier as a result). I was able to participate in both AP and CP rotations, but was required to do 2 months general pathology with a heavy surgical focus at the V.A., 2 months of University surgical path, and 2 months of bone marrows. I had 6 months of elective time which I opted to spend 2 months forensics (>50 post-mortems!), 2 months occupational lung, renal, and neuro. I wasn't nearly as interested in CP. As far as research goes, it probably depends on your interest and commitment. Dr. Jerry Abraham is a world-class occupational lung pathologist whom I spent considerable time with in his lab. We recently presented (I was first author) a paper at the British Occupational Hygiene Society Inhaled Particles IX Symposium in Cambridge UK in September. All of my costs were paid for, and my husband and I got a vacation to boot. This was also an international collaboration with epidemiologist/pathologist Dr. Bruce Case out of McGill. I have another paper in revision with Human Pathology (again first author with Dr. Abraham.) All this being said, I am not really bragging (much ). I am a rather average, though motivated student. My main reason for taking the fellowship was because the first 2 years of school wiped me out. Another fellow wrote an appendix for the update of John B. Henry's Clin. Path tome. The pathology door is wide open for enthusiastic, particularly American-trained students. If you have an interest in pathology, and a year to spare, I cannot recommend a better way to explore the career, boost your resume, and learn medicine from its foundation.

 

[Mindy]

Oh yeah, to answer your question GP20! :
1)Go to AMA/FREIDA for path residencies and just look for post-soph advertisements

2)I received a $17000 stipend for the year

 

[brownman]

scrubs-

I am so sorry to hear about your experiences. As a medical doctor considering anesthesia (more to do pain management than anything) I have to admit, i am surprised at the level of disgruntlement you posess. I did a one month rotation at Stanford, and I have to genuinely say that none of the problems you have addressed have surfaced. The residents are happy, they have free time, they get great job offers (which I concede is a market force issue), and they are truly respected by the surgeons (in fact, the surgeons tend to hang out with the anesthesia professors on a regular basis and many times the anesthesia staff start procedural points for the IV radiologists). I'm sorry that your anesthesia experience has been so miserable. I remember when I did surgery as a med student, I hated it so much for the first six weeks, but when the residents started to loosen up and it wasn't so anal retentive...things became much easier. The people in any field, make it worth it. If the people you are with are jerks, then even radiology can be miserable (as I can attest to from a one month rotation at the U of Utah...avoid that place like the plague). In closing (sorry for the prolonged epitome), if you detest anesthesia as a field (and honestly introspect yourself to gauge this) then you should seriously think about pathology. My sister and brother in law are in pathology and they love it. They and their associates are some of the brightest people I've ever met, and they love the intellectual challenge of it all (mad amounts of disease physiology). Don't be fooled...they get up early (5:00 AM everyday), some of their services are ludicrously busy...but they don't have significant call, they enjoy their weekends (sometimes) and they feel intellectually stimulated.

I will relate a story before it's all said and done here. I once thought about being a neurosurgeon, and rotated on the service at my med school. ONE CALL I STAYED UP 96 CONSECUTIVE HOURS....96! For those counting at home...that is four consecutive days, and for the span of a year...that is what these guys did. Yes...shizz does hit the fan in anesthesia, yes CRNA's are cutting in on some of our turf (I could get into a statement of risk analysis, insurance premiums, and nurses...but because I've talked endlessly already...I won't), and surgeons can be complete tools..but no field in medicine is not without it's negatives. My biggest fear about anesthesia is that I will BE BORED..NOT STRESSED. I'm glad to hear there's any stress at all. Medicine is the ultimate catch 22...the lifestyle fields are repitious, and the non-lifestyle fields..don't allow you to have a life. You are in a field...all things considered..that isn't so bad. The shock of the first few months is getting to you...understandable. If you feel this way into January...you should switch. But give it some more time..the grass may not necessarily be greener on the other side.

Good luck...and I'm OUT!

 

[GreatPumpkin]

Mindy,

Off-beat, huh?! Never.(sarcastic voice)

Ok, but like you said most pathologists are very friendly and happy about their jobs. If nothing else that says a ton about the specialty. And, pathologist keep working till they are ancient because they love it. If med students had to do a rotation in path it would be a lot more competitive. Oh well more jobs for me!

 

[Amadeus]

Every field out there has pluses and negatives. People say radiology is a good field but interventionalist are basically running a surgeon's schedule and many people will hate being in the dark room looking at film after film. Anesthesia as you've heard has its negatives...but at least you are not running from pt to pt, laying in the dark, or have no pt contact. Correct me if I am wrong but I hear that the job market in path has been rough for quite a while.

 

[GreatPumpkin]

The job market in path is not that bad. Everyone talks about or hears that it is bad, but I don't know of any unemployed pathologists. In the mid 90s the market was bad. It has bounced back just like the other specialties that had it tough when medicare cut back on reimbursement. Path is not a job were you can say I have to stay in "city x" you need to be somewhat flexable. And, if you are a US trained doctor in path you really have the upper hand in the job market. Whether acceptable or not FMGs have the harder time finding employment. The people that have graduated from my program over the last few years have had multiple job offers in very nice positions. Hopefully the Amer. Society of Pathologists will release the new employment survey relatively soon so the old numbers will quit haunting us.

Here is a nice page with some good path numbers. Salary web page

 

[Justin4563]

Scrubs::


First of all, I agree with scrubs about anesthesia. We are physicians who are always pressured and rushed all day long. The decisions and problems we face are always critical as scrubs mentioned(Airway mishaps, (see professor benumof's article from sandiego truly wonderful), malignant hyperthermia, massive blood loss, major trauma, hypotension, cardiac arrest, preeclampsia, pedi emrgencies etc.. we see it all on a daily basis. This coupled with the fact that we dont have time to really think about all these problems. just split second decisions and surgeons who are truly obtuse and dont really understand the role of anesthesiologists. can make your life stressful.. Now if you are a resident at any hospital that is indigent you will have added stress in your life. So all in all this maked for stress ful life style.You have to learn how to deal with all this stress; and deep down most of us thrive on it and we could not do any thign else in medicine..


another thing, the science of anestheisa is much differen fron anything else in medicine..a lot of critical care, physics mathematics and pharmacology.... very basic science oriented... less anatomy and the like.So if you think like this you like anesthesia,,, Hey scrubs stick with it Im in the same boat you are proba worse program and im going with the flow... you can email me if you want...

 

[DO2]

Report: U.S. Facing Shortage of Anesthesiologists
NEW YORK (Reuters Health) - There is a shortage of anesthesiologists in the US that will continue for years unless more people are attracted to the field, according to a report in the October issue of the Mayo Clinic Proceedings.

``It appears now that, in addition to focusing on the financial resources needed to support the healthcare needs of an aging population, national health policymakers need to re-examine whether the number of healthcare professionals is sufficient to care for the elderly, in particular when they require surgery, are afflicted by painful conditions, or become critically ill,'' Dr. Armin Schubert from the Cleveland Clinic Foundation said in a clinic statement.

Schubert and colleagues used data from federal agencies, the American Medical Association and the American Society of Anesthesiologists to estimate the supply of anesthesiologists in 2001 and beyond.

Based on the growth of the need for anesthesia since 1994, there is currently a shortage of anesthesiologists that ranges from 1,200 to 3,800, the investigators determined. They calculated that by 2005, assuming continued growth, the shortage will increase to between 1,000 and 4,500 anesthesiologists.

However, by 2010 the shortage may disappear or be reduced to a shortfall of 1,000 anesthesiologists, assuming that the number of residency positions increases by 15% per year until 2006, Schubert's team notes.

The researchers believe that to address the shortage, almost 60% more anesthesiologists will need to be trained by 2005 than were graduated in 2000, and almost 100% more will need to be trained by 2010.

The need to increase the number of anesthesiologists suggests that training programs should admit more graduates of foreign medical schools, according to the authors. They add that the Medicare fee structure needs to be modified to allow anesthesiologists to earn more, in order to attract people to the field.

In an accompanying editorial, Dr. Ronald D. Miller from the University of California, San Francisco and Dr. William L. Lanier, editor-in-chief of the journal, note that the shortfall of anesthesiologists results from policies in the 1990s that encouraged a return to general practice.

``It can happen in other specialties as well,'' Miller and Lanier note. ``Ultimately, the erosion of any important component specialty will do harm to the future intellectual and service missions of medicine and, unfortunately, the patients we serve.''

SOURCE: Mayo Clinic Proceedings 2001;76:969-970, 995-1010.

 

[OT_Still]

Justin,

QUOTE] We are physicians who are always pressured and rushed all day long. The decisions and problems we face are always critical as scrubs mentioned(Airway mishaps, (see professor benumof's article from sandiego truly wonderful), malignant hyperthermia, massive blood loss, major trauma, hypotension, cardiac arrest, preeclampsia, pedi emrgencies etc.. we see it all on a daily basis.[ [/QUOTE]

Where are you working at?: I am hoping you are in a critical care unit/trauma setting, because I would be inclined to disagree that this description would fit a typical day. Having worked with anesthesia teams at several locations, this does not seem to be the norm. Besides, if MH, airway mishaps and cardiac arrests occur on a
daily basis, perhaps there are some training issues. Yikes!

 

[Magree]

Hi:

Does anyone who is interviewing know what the applicant pool looks like - substantially up or a little up etc.? Just curious.

Cheers,

M-

 

[brownman]

substantially up....will be pretty competitive next year. When I set up my interview at Hopkings, she said that they had to weed through 800 applicants just to select a 100 to interview. And interview spots were being taken up fast. According to her, by predominantly american medical graduates. We'll see....

 

[Sandpaper]

Yup, waaaay...up this year. Last year, only one from our school even applied for anesthesia. This year, we got about seven or eight applicants, with about half of them being strong AOA folks. And this from a well-respected primary care school. The administration must be pulling their hair out right about now. Gonna be like radiology in terms of competitiveness in a few years. Apply while you can.